Why socialized medicine is inevitable
sinister
insurance (so-called "national health insurance")---is inevitable for
reasons of economic efficiency. This follows from the unique nature of the
health care market, as made clear from this excerpt from Phillip Longman,
"The best care anywhere," _Washington Monthly_, Jan/Feb 2005, pp. 39--48,
URL: http://www.washingtonmonthly.com/features/2005/0501.longman.html
[note: VHA = Veterans Health Administration]
--------------------------------------begin
excerpt-----------------------------------------------------
Why care about quality?
Here's one big reason. As Lawrence P. Casalino, a professor of public health
at the University of Chicago, puts it, "The U.S. medical market as presently
constituted simply does not provide a strong business case for quality."
Casalino writes from his own experience as a solo practitioner, and on the
basis of over 800 interviews he has since conducted with health-care leaders
and corporate health care purchasers. While practicing medicine on his own
in Half Moon Bay, Calif, Casalino had an idealistic commitment to following
emerging best practices in medicine. That meant spending lots of time
teaching patients about their diseases, arranging for careful monitoring and
follow-up care, and trying to keep track of what prescriptions and
procedures various specialists might be ordering.
Yet Casalino quickly found out that he couldn't sustain this commitment to
quality, given the rules under which he was operating. Nobody paid him for
the extra time he spent with his patients. He might have eased his burden by
hiring a nurse to help with all the routine patient education and follow-up
care that was keeping him at the office too late. Or he might have teamed up
with other providers in the area to invest in computer technology that would
allow them to offer the same coordinated care available in veterans
hospitals and clinics today. Either step would have improved patient safety
and added to the quality of care he was providing. But even had he managed
to pull them off, he stood virtually no chance of seeing any financial
return on his investment. As a private practice physician, he got paid for
treating patients, not for keeping them well or helping them recover faster.
The same problem exists across all health-care markets, and its one main
reason in explaining why the VHA has a quality performance record that
exceeds that of private-sector providers. Suppose a private managed-care
plan follows the VHA example and invests in a computer program to identify
diabetics and keep track of whether they are getting appropriate follow-up
care. The costs are all upfront, but the benefits may take 20 years to
materialize. And by then, unlike in the VHA system, the patient will likely
have moved on to some new health-care plan. As the chief financial officer
of one health plan told Casalino: "Why should I spend our money to save
money for our competitors?"
Or suppose an HMO decides to invest in improving the quality of its diabetic
care anyway. Then not only will it risk seeing the return on that investment
go to a competitor, but it will also face another danger as well. What
happens if word gets out that this HMO is the best place to go if you have
diabetes? Then more and more costly diabetic patients will enroll there,
requiring more premium increases, while its competitors enjoy a
comparatively large supply of low-cost, healthier patients. That's why,
Casalino says, you never see a billboard with an HMO advertising how good it
is at treating one disease or another. Instead, HMO advertisements generally
show only healthy families.
In many realms of health care, no investment in quality goes unpunished. A
telling example comes from semi-rural Whatcom County, Wash. There,
idealistic health-care providers banded together and worked to bring down
rates of heart disease and diabetes in the country. Following best practices
from around the country, they organized multi-disciplinary care teams to
provide patients with counseling, education, and navigation through the
health-care system. The providers developed disease protocols derived from
evidence-based medicine. They used information technology to allow
specialists to share medical records and to support disease management.
But a problem has emerged. Who will pay for the initiative? It is already
greatly improving public health and promises to bring much more business to
local pharmacies, as more people are prescribed medications to manage their
chronic conditions and will also save Medicare lots of money. But
projections show that, between 2001 and 2008, the initiative will cost the
local hospital $7.7 million in lost revenue, and reduce the income of the
county's medical specialists by $1.6 million. An idealistic commitment to
best practices in medicine doesn't pay the bills. Today, the initiative
survives only by attracting philanthropic support, and, more recently, a
$500,000 grant from Congress.
For health-care providers outside the VHA system, improving quality rarely
makes financial sense. Yes, a hospital may have a business case for
purchasing the latest, most expensive imaging devices. The machines will
help attract lots of highly-credentialed doctors to the hospital who will
bring lots of patients with them. The machines will also induce lots of new
demand for hospital services by picking up all sorts of so-called
"pseudo-diseases." These are obscure, symptomless conditions, like tiny,
slow-growing cancers, that patients would never have otherwise become aware
of because they would have long since died of something else. If you're a
fee-for-service health-care provider, investing in technology that leads to
more treatment of pseudo-disease is a financial no-brainer.
But investing in any technology that ultimately serves to reduce hospital
admissions, like an electronic medical record system that enables more
effective disease management and reduces medical errors, is likely to take
money straight from the bottom line. "The business case for safety.remains
inadequate.[for] the task," concludes Robert Wachter, M.D., in a recent
study for Health Affairs in which he surveyed quality control efforts across
the U.S. health-care system.
If health care was like a more pure market, in which customers know the
value of what they are buying, a business case for quality might exist more
often. But purchasers of health care usually don't know, and often don't
care about its quality, and so private health-care providers can't increase
their incomes by offering it. To begin with, most people don't buy their own
health care; their employers do. Consortiums of large employers may have the
staff and the market power necessary to evaluate the quality of health-care
plans and to bargain for greater commitments to patient safety and
evidence-based medicine. And a few actually do so. But most employers are
not equipped for this. Moreover, in these days of rapid turnover and
vanishing post-retirement health-care benefits, few employers have any
significant financial interest in their workers' long-term health.
That's why you don't see many employers buying insurance that covers smoking
cessation programs or the various expensive drugs that can help people to
quit the habit. If they did, they'd be being buying more years of healthy
life per dollar than just about any other way they could use their money.
But most of the savings resulting from reduced lung cancer, stroke, and
heart attacks would go to future employers of their workers, and so such a
move makes little financial sense.
Meanwhile, what employees value most in health care is maximum choice at
minimal cost. They don't want the boss man telling them they must use this
hospital or that one because it has the best demonstrated quality of care.
They'll be their own judge of quality, thank-you, and they'll usually base
their choice on criteria like: "My best friend recommended this hospital,"
or "This doctor agrees with my diagnosis and refills the prescriptions I
want," or "I like this doctor's bedside manner." If more people knew how
dangerous it can be to work with even a good doctor in a poorly run hospital
or uncoordinated provider network, the premium on doctor choice would be
much less decisive, but for now it still is.
And so we get results like what happened in Cleveland during the 1990s.
There, a well-publicized initiative sponsored by local businesses, hospitals
and physicians identified several hospitals as having significantly higher
than expected mortality rates, longer than expected hospital stays, and
worse patient satisfaction. Yet, not one of these hospitals ever lost a
contract because of their poor performance. To the employers buying health
care in the community, and presumably their employees as well, cost and
choice counted for more than quality. Developing more and better quality
measures in health care is a noble cause, but it's not clear that putting
more information into health-care markets will change these hard truths.
----------------------------------------end
excerpt-----------------------------------------------------
ro...@telus.net
wrote:
An excellent post. Too bad people like Kolker and Mental Disease are
not intelligent enough to understand it.
-- Roy L
sinister
<Big Dog> wrote in message
news:2omh111hesgt8ubpt...@4ax.com...
> On Sun, 20 Feb 2005 16:45:27 GMT, "sinister" <sini...@nospam.invalid>
> wrote:
>
>>insurance (so-called "national health insurance")---is inevitable for
>>reasons of economic efficiency.
>
> economically. We should not treat those that doctors do not think
> will recover a good quality of life. That is economic efficiency.
> Frankly, I am more concerned with medical quality.
[Sigh] Clearly you didn't read the excerpt. If you did, you'd understand
that we can improve both efficiency and quality simultaneously, and that the
reason for this has to do with the particular nature of the health care
market.
> Thanks,
> Big Dog
>
>
sinister
<ro...@telus.net> wrote in message news:4218d336...@news.telus.net...
Thanks.
I really liked the article, because it went over and gave detailed form to
many of my own thoughts about health care economics. Especially the part
about providers and insurers not having an incentive to improve quality of
care and long-term health, because they likely won't capture any of the
resulting (far into the future) cost savings.
Only thing I often harp on that wasn't stressed much was my notion that MDs
form these little practice groups in order to facilitate rent-seeking, at
the cost of lack of efficient economies of scale.
Best,
S
>
> -- Roy L
robert j. kolker
sinister wrote:
> And so we get results like what happened in Cleveland during the 1990s.
> There, a well-publicized initiative sponsored by local businesses, hospitals
> and physicians identified several hospitals as having significantly higher
> than expected mortality rates, longer than expected hospital stays, and
> worse patient satisfaction. Yet, not one of these hospitals ever lost a
> contract because of their poor performance. To the employers buying health
> care in the community, and presumably their employees as well, cost and
> choice counted for more than quality. Developing more and better quality
> measures in health care is a noble cause, but it's not clear that putting
> more information into health-care markets will change these hard truths.
Do you really and truly believe that having government run medical
services will assure their quality? Where is the incentive? Consider for
a moment the quality of our state funded and run public schools. If this
as a harbinger of quality assurance under tha aegis of government, we
are in for a really bad time.
On the other hand our supermarkets which are regulated to some degree
but otherwise free market entities provide quality food with a minimum
of government regulation and intervention. Do you think that medical
services can be sold like calavoes are sold at the local supermarket. If
so, that is the way to run a good medical service system. Like the local
supermarket.
Do you also notice something else. There is no third party involved when
you buy food. There is no "food insurance". There is the customer and
there is the vendor and his supply chain. No third party determining how
much food a person will get and at what quality. The only way to have a
good medical supply system is to remove third parties from the transaction.
Bob Kolker
Bob Kolker
sinister
"robert j. kolker" <now...@nowhere.net> wrote in message
news:37s832F...@individual.net...
>
>
> sinister wrote:
>
>> And so we get results like what happened in Cleveland during the 1990s.
>> There, a well-publicized initiative sponsored by local businesses,
>> hospitals
>> and physicians identified several hospitals as having significantly
>> higher
>> than expected mortality rates, longer than expected hospital stays, and
>> worse patient satisfaction. Yet, not one of these hospitals ever lost a
>> contract because of their poor performance. To the employers buying
>> health
>> care in the community, and presumably their employees as well, cost and
>> choice counted for more than quality. Developing more and better quality
>> measures in health care is a noble cause, but it's not clear that putting
>> more information into health-care markets will change these hard truths.
>
> Do you really and truly believe that having government run medical
> services will assure their quality? Where is the incentive? Consider for a
> moment the quality of our state funded and run public schools. If this as
> a harbinger of quality assurance under tha aegis of government, we are in
> for a really bad time.
Education does not equal medical care.
> On the other hand our supermarkets which are regulated to some degree but
> otherwise free market entities provide quality food with a minimum of
> government regulation and intervention. Do you think that medical services
> can be sold like calavoes are sold at the local supermarket. If so, that
> is the way to run a good medical service system. Like the local
> supermarket.
Health care is not a commodity with differences in value easily discernable
by a consumer. The article addresses this point.
> Do you also notice something else. There is no third party involved when
> you buy food. There is no "food insurance". There is the customer and
> there is the vendor and his supply chain. No third party determining how
> much food a person will get and at what quality. The only way to have a
> good medical supply system is to remove third parties from the
> transaction.
Yes, that might help, but the article points out that doctors and other
health care providers (a) resist evidence-based medicine, (b) still have no
financial incentive to consider the *long-term* health of their patients.
> Bob Kolker
>
>
> Bob Kolker
MS
>
>
> sinister wrote:
>
>> And so we get results like what happened in Cleveland during the 1990s.
>> There, a well-publicized initiative sponsored by local businesses,
>> hospitals
>> and physicians identified several hospitals as having significantly
>> higher
>> than expected mortality rates, longer than expected hospital stays, and
>> worse patient satisfaction. Yet, not one of these hospitals ever lost a
>> contract because of their poor performance. To the employers buying
>> health
>> care in the community, and presumably their employees as well, cost and
>> choice counted for more than quality. Developing more and better quality
>> measures in health care is a noble cause, but it's not clear that putting
>> more information into health-care markets will change these hard truths.
>
>
> Do you really and truly believe that having government run medical
> services will assure their quality? Where is the incentive? Consider for
> a moment the quality of our state funded and run public schools. If this
> as a harbinger of quality assurance under tha aegis of government, we
> are in for a really bad time.
Every proposal I've seen for "fixing" health care involves the
government in the role of bill payer. Hospital and physicians
would deliver care privately to their patients. Perhaps better
data could be collected so patients and their doctors could make
better choices?
robert j. kolker
sinister wrote:
>
> Education does not equal medical care.
That is right. It is much simpler and easier to provide and no one's
life is in danger. If the government cannot do the simpler and easier
well, why should we assume it can do the more difficult well?
If the government cannot walk a straight line why should we assume it
can chew gum.
Bob Kolker
robert j. kolker
MS wrote:
> Every proposal I've seen for "fixing" health care involves the
> government in the role of bill payer. Hospital and physicians would
> deliver care privately to their patients. Perhaps better data could be
> collected so patients and their doctors could make better choices?
What is this telling me? Badly done medicine will be paid for a readily
as well done medical service. In short there is no incentive to excel in
quality.
Bob Kolker
tonyp
"robert j. kolker" <now...@nowhere.net> wrote
> > Education does not equal medical care.
>
> That is right. It is much simpler and easier to provide and no one's
> life is in danger. If the government cannot do the simpler and easier
> well, why should we assume it can do the more difficult well?
Why do you think that education is "easier" than medical care?
> If the government cannot walk a straight line why should we assume it
> can chew gum.
Or shoot down incoming ballistic missiles, for that matter?
-- TP
robert j. kolker
sinister wrote:
>
> First, I don't think education is "simple"; all I said is that it's not
> equal to health.
No. But it is a service.
>
> Second, the article provides the answer---the VHA is government run, and it
> is far more efficient and offers far higher average quality of care than the
> private system.
Have you ever visited a VA Hosipital. I have. They are dismal and grim.
Bob Kolker
robert j. kolker
sinister wrote:
>
> And there's now empirical evidence that this is true. Re-read the excerpt
> (really, read the entire article, at the URL).
I read the article and I consult my own experieince in dealing with
governments as various levels. I would prefer a wide open capitalistic
free for all in medicine with no licensure. There will be a wide range
of options and if the consumer is careful he will get his money's worth.
I like the supermarket model best of all. Supermarkets provide good food
over a wide range of prices and all good quality with respect to a given
price range. Competition is what makes it tick.
Bob Kolker
sinister
"MS" <mik...@iname.com> wrote in message
news:EkiSd.448920$Xk.156429@pd7tw3no...
> robert j. kolker wrote:
>>
>>
>> sinister wrote:
>>
>>
>>>
>>> Education does not equal medical care.
>>
>>
>> That is right. It is much simpler and easier to provide and no one's life
>> is in danger. If the government cannot do the simpler and easier well,
>> why should we assume it can do the more difficult well?
>>
>
Yes, though in this case, they are employees of the government.
MS
>>profits.
>
>
> It's a little more subtle than that, but the effect is of course still very
> pronounced.
I know. I was trying to keep it simple :-)
>
> If consumers could easily evaluate quality and not get distracted (as per
> examples listed in the excerpt) AND price signals picked up the long-term
> health of the patient, things would be fine. But those two don't obtain,
> and hence the health care market won't work.
>
> I myself am not *strongly* biased against private organizations filling the
> role that the VHA does in the article. I just don't see how price signals
> can get things right.
>
> So the problem isn't profits per se.
MS
Please read that excerpt. There is no incentive now -- it's all
about profits.
>
> Bob Kolker
sinister
"robert j. kolker" <now...@nowhere.net> wrote in message
news:37slo7F...@individual.net...
Which is exactly the point of my post: socialized medicine is inevitable,
because market incentives and price signals won't get quality right.
And there's now empirical evidence that this is true. Re-read the excerpt
(really, read the entire article, at the URL).
>
> Bob Kolker
MS
> that hospitals should be run by the government and physicians should be
> employeed by the government.
>
> The excerpt I posted quite clearly shows that private-sector physicians and
> hospitals have no economic incentive to provide health care based on the
> long-term health of the patient.
I do understand the post and thank you for posting the link and
excerpt.
Private hospitals are profit maximizers. If increasing quality,
does not lead to increased profits, then why improve quality,
right? There is no doubt that not-for-profit hospitals provide
better care than for profit hospitals (see articles by
Himmelstein and Woolhandler).
However, physicians are not profit maximizers; in the health
economics literature they're usually considered utility
maximizers. Besides consumption and leisure, their utility
functions usually have a term for practice style. There is a
disutility for physicians from not doing the best they can for
their patients. I think in general, the care provided by
physicians remunerated by salary, ffs, or through capitation are
equivalent. I know of no study that shows anything to the contrary.
sinister
>
>
> sinister wrote:
>
>
>>
>> Education does not equal medical care.
>
> That is right. It is much simpler and easier to provide and no one's life
> is in danger. If the government cannot do the simpler and easier well, why
> should we assume it can do the more difficult well?
First, I don't think education is "simple"; all I said is that it's not
equal to health.
Second, the article provides the answer---the VHA is government run, and it
is far more efficient and offers far higher average quality of care than the
private system.
> If the government cannot walk a straight line why should we assume it can
> chew gum.
>
> Bob Kolker
sinister
It's a little more subtle than that, but the effect is of course still very
pronounced.
If consumers could easily evaluate quality and not get distracted (as per
examples listed in the excerpt) AND price signals picked up the long-term
health of the patient, things would be fine. But those two don't obtain,
and hence the health care market won't work.
I myself am not *strongly* biased against private organizations filling the
role that the VHA does in the article. I just don't see how price signals
can get things right.
So the problem isn't profits per se.
>
>>
>> Bob Kolker
sinister
The point of my post is that government should also be the provider, meaning
that hospitals should be run by the government and physicians should be
employeed by the government.
The excerpt I posted quite clearly shows that private-sector physicians and
hospitals have no economic incentive to provide health care based on the
long-term health of the patient.
robert j. kolker
MS wrote:
>
>
> Please read that excerpt. There is no incentive now -- it's all about
> profits.
And when the government is right in the middle it will be all about
power and turf.
There are no good governments in the world. Just bad ones and worse ones.
Bob Kolker
robert j. kolker
MS wrote:
>
> The government isn't providing medicine; physicians and nurses are.
You are ignoring the effects of government regulations and constraints
on services. If the government gets into the act, medical services will
be rationed. Also govern rules of licensure affect the availability of
medical personal. Do direct managment is not required to have a real
effect on services rendered.
You may as well argue that government isn't providing public schooling,
teachers are. But the involvement of goverment in the process has
produced our famously piss poor public schools.
As I said: if government involvement in the simpler matter of schooling
has produced such dismal results, what will government involvement in
the providison of medical services do?
When you want services provided at a reasonable price over a wide range
of price and service options, you use a free market or freer market
model. Your local supermarket provides an excellent choice of edibles at
a price you and I can afford. The government is involved in that process
miminally (laws and commercial regulations). The market is competitive.
If medical services can be provided in a model that resemebles the
suprmarket model I suggest we may be better served than we are now.
Bob Kolker
robert j. kolker
sinister wrote:
>
> The excerpt I posted quite clearly shows that private-sector physicians and
> hospitals have no economic incentive to provide health care based on the
> long-term health of the patient.
And the bosses of the doctors under your proposed scheme will be
government burocrats and lackeys. The bosses of your postman constitute
the U.S. Postal Service and we know what a wonder of efficiency that is.
That is why the U.S. government uses FedEx and Mr. Brown to ship their
parcels.
Bob Kolker
>
>
MS
>
>
> sinister wrote:
>
>
>>
>> Education does not equal medical care.
>
>
> That is right. It is much simpler and easier to provide and no one's
> life is in danger. If the government cannot do the simpler and easier
> well, why should we assume it can do the more difficult well?
>
The government isn't providing medicine; physicians and nurses are.
Gordon Sande
robert j. kolker wrote:
>
>
> Ron Peterson wrote:
>
>>
>>
>> How would an incentive for quality medical services be implemented?
>
>
> A competitive capitalist free for all. Like the used car market. If you
> are careful you can buy a really good (for the money) used car. In a
> capitalist free for all, if the consumer is really careful he can get
> good medical service.
>
> I manage to buy my food inexpensively, well within my income, and of
> good to excellent quality in a competitive system. Yes, it is somewhat
> regulated by law (to prevent blatant negligence and fraud) but it is
> mostly competitive. If I can get good things to eat without the
> providers being government employes why could I not get good or at least
> adequate medical services?
>
> If the government were to tell us when to sow and when to reap all would
> be wanting for bread.
>
> Remember the school teachers are government employees and the U.S. has
> one of the highest functional illiteracy rates in the world. In addition
> the public is largely innumerate (ignorant of mathematics) and highly
> ignorant of science. This is your government system at work. I ask
> again, why should a government run medical service system be any better?
But the other school systems are government run. Just different
governments with different political systems driving them. In
many systems the political parties are capable of providing
coherent national policies because of subtle differences in
the incentives that the parties operate under. Little issues
like funding of parties and internal mechanisms for choosing
party leadership.
Many problems attributed to governments can also be found in
large outfits like (the departed) AT&T or (the downsizing) GM.
> If the government were running John Hopkins medical school Dr. Blalock
> and Vivian Thomas never would have been permitted to develop open heart
> surgery. Government is about turf, power, burocratic feifdoms and covery
> your ass at all costs. Those who can, go into business for themselves.
> Those who cannot either teach or go to work for government.
>
> Bob Kolker
robert j. kolker
sinister wrote:
>
> But I'm sure you'll persist, since facts and substantial arguments never
> seem to sway you.
I see how government runs and is run every day. My skepticism is
perfectly justified. At one time in my life I worke for a government run
laborator so I saw what I saw. I saw power games, feifdoms and
cover-your-ass at work. Government run -anything- is bad news especially
if we try it in the United States. The U.S. has one of the most
incompetent governments in the world. Ain't democracy wonderful?
Do you expect a largely illiterate and ignorant voting public to make
things work right? If we did something simple like requiring voters to
enumerate the rights in the Bill of Rights as a condition for voting,
only ten percent of the population would be allowed to vote.
Bob Kolker
Ron Peterson
How would an incentive for quality medical services be implemented?
--
Ron
robert j. kolker
Ron Peterson wrote:
>
>
> How would an incentive for quality medical services be implemented?
A competitive capitalist free for all. Like the used car market. If you
are careful you can buy a really good (for the money) used car. In a
capitalist free for all, if the consumer is really careful he can get
good medical service.
I manage to buy my food inexpensively, well within my income, and of
good to excellent quality in a competitive system. Yes, it is somewhat
regulated by law (to prevent blatant negligence and fraud) but it is
mostly competitive. If I can get good things to eat without the
providers being government employes why could I not get good or at least
adequate medical services?
If the government were to tell us when to sow and when to reap all would
be wanting for bread.
Remember the school teachers are government employees and the U.S. has
one of the highest functional illiteracy rates in the world. In addition
the public is largely innumerate (ignorant of mathematics) and highly
ignorant of science. This is your government system at work. I ask
again, why should a government run medical service system be any better?
If the government were running John Hopkins medical school Dr. Blalock
sinister
>
>
> sinister wrote:
>>
>> First, I don't think education is "simple"; all I said is that it's not
>> equal to health.
>
> No. But it is a service.
So what? It doesn't mean it's equal to education in any sense.
>>
>> Second, the article provides the answer---the VHA is government run, and
>> it is far more efficient and offers far higher average quality of care
>> than the private system.
>
> Have you ever visited a VA Hosipital. I have. They are dismal and grim.
The article claims that's the *old* VA, whereas the *new* VA provides much
better health care than the private sector on average.
But I'm sure you'll persist, since facts and substantial arguments never
seem to sway you.
>
> Bob Kolker
>
tonyp
"robert j. kolker" <now...@nowhere.net> wrote
> I see how government runs and is run every day. My skepticism is
> perfectly justified. At one time in my life I worke for a government run
> laborator so I saw what I saw. I saw power games, feifdoms and
> cover-your-ass at work.
Having worked for two large tech companies and seen the inside of several
others, I can assure you there are plenty of "power games, fiefdoms, and
cover-your-ass" in the private sector too.
> Government run -anything- is bad news especially
> if we try it in the United States. The U.S. has one of the most
> incompetent governments in the world. Ain't democracy wonderful?
A truly competent government would be a two-edged sword.
> Do you expect a largely illiterate and ignorant voting public to make
> things work right? If we did something simple like requiring voters to
> enumerate the rights in the Bill of Rights as a condition for voting,
> only ten percent of the population would be allowed to vote.
And most of them would be naturalized citizens. Some of us _have_ passed
the sort of test you advocate.
-- TP
robert j. kolker
Gordon Sande wrote:
> Many problems attributed to governments can also be found in
> large outfits like (the departed) AT&T or (the downsizing) GM.
Underline (the departed) AT&T. Departed without bloodshed and without
revolution. Can be get rid of bad government as easily?
Bob Kolker
sinister
>
>
> sinister wrote:
>>
>> But I'm sure you'll persist, since facts and substantial arguments never
>> seem to sway you.
>
> I see how government runs and is run every day. My skepticism is perfectly
> justified. At one time in my life I worke for a government run
Your skepticism is faith-based.
> laborator so I saw what I saw. I saw power games, feifdoms and
> cover-your-ass at work. Government run -anything- is bad news especially
Sure...that *never* happens in the corporate world. LOL! And as if there
are no private fiefdoms in private medicine---such as every single
iddy-biddy little single proprietor or small partnership of MDs.
> if we try it in the United States. The U.S. has one of the most
> incompetent governments in the world. Ain't democracy wonderful?
Democracy is the worst form of government, except for all the alternatives.
> Do you expect a largely illiterate and ignorant voting public to make
> things work right? If we did something simple like requiring voters to
> enumerate the rights in the Bill of Rights as a condition for voting, only
> ten percent of the population would be allowed to vote.
Ergo, the entire federal government should be wiped out of existence.
Unless you want to continue buffing up your reputation as a rabid
anti-empiricist, please provide links to any evidence that the main
empirical claim in the article---that the VHA is now providing high-quality
health care---is wrong.
>
> Bob Kolker
robert j. kolker
sinister wrote:
> Unless you want to continue buffing up your reputation as a rabid
> anti-empiricist, please provide links to any evidence that the main
> empirical claim in the article---that the VHA is now providing high-quality
> health care---is wrong.
High quality in comparison to what? Who made the determination. By what
objective criteria? Why should I believe this?
Even granting the point there is no assurance that the government will
supply high quality care nationwide to everyone. Governments have a very
bad record in quality and efficiency.
Let me ask you a question. Would you like the entire food production and
distribution system of the counry government run? Would you expect to be
as well fed? Do you want the workers in the local food store to be
government employees? If government is so great why not have it run
everything?
Bob Kolker
ro...@telus.net
<now...@nowhere.net> wrote:
>sinister wrote:
>>
>> But I'm sure you'll persist, since facts and substantial arguments never
>> seem to sway you.
>
>I see how government runs and is run every day. My skepticism is
>perfectly justified. At one time in my life I worke for a government run
>laborator so I saw what I saw. I saw power games, feifdoms and
>cover-your-ass at work.
Gee, that sounds exactly like what I have seen at privately owned
workplaces....
>Government run -anything- is bad news especially
>if we try it in the United States. The U.S. has one of the most
>incompetent governments in the world. Ain't democracy wonderful?
The results don't look all that bad, compared to much of what history
records. By any reasonable historical measure, the USA has been a
success.
>Do you expect a largely illiterate and ignorant voting public to make
>things work right?
They don't have to make things work right. All they have to do is
pick people who are smart and honest enough to make things work right.
>If we did something simple like requiring voters to
>enumerate the rights in the Bill of Rights as a condition for voting,
>only ten percent of the population would be allowed to vote.
I definitely agree that voters should be required to pass a test that
shows they understand, at least minimally, what they are voting on.
-- Roy L
ro...@telus.net
Yet history shows clearly that a government must be very bad indeed to
be worse than no government.
-- Roy L
ro...@telus.net
<root@localhost.> wrote:
>The profits are the invcentive, you retard. Lousy service => no
>profits.
<sigh> The article explained why that claim is false. In the medical
industry, it is entirely possible, and indeed routine, to obtain large
profits while providing lousy service, and lower profits for better
service. See Vioxx. As I predicted, you are not intelligent enough
to understand these facts.
-- Roy L
ro...@telus.net
<now...@nowhere.net> wrote:
>sinister wrote:
>
>> And there's now empirical evidence that this is true. Re-read the excerpt
>> (really, read the entire article, at the URL).
>
>I read the article and I consult my own experieince in dealing with
>governments as various levels.
Yes, isn't it amazing how when government officials enter the private
sector, they somehow suddenly become perfect, and no longer make any
mistakes?
>I would prefer a wide open capitalistic
>free for all in medicine with no licensure. There will be a wide range
>of options and if the consumer is careful he will get his money's worth.
Wrong. Whether he is careful or not, he might get his money's worth,
or he might be killed.
>I like the supermarket model best of all. Supermarkets provide good food
>over a wide range of prices and all good quality with respect to a given
>price range. Competition is what makes it tick.
The article, which you claim to have read, explained (but you are
evidently not intelligent enough to understand) why competition
_cannot_ work the same way in health care as in supermarkets. You are
also not honest enough to be willing to know the fact that VHA
hospitals achieve better outcomes than private hospitals.
-- Roy L
MS
> I like the supermarket model best of all. Supermarkets provide good food
> over a wide range of prices and all good quality with respect to a given
> price range. Competition is what makes it tick.
So that's your plan: If the health care smells good and doesn't
have bruises, you will purchase it?
MS
> On Mon, 21 Feb 2005 10:04:27 GMT, MS <mik...@iname.com> wrote:
>
>>robert j. kolker wrote:
>>
>>Please read that excerpt. There is no incentive now -- it's all
>>about profits.
>>
>
>
> The profits are the invcentive, you retard. Lousy service => no
> profits.
>
>
Shhhh, quiet while the adults are talking dear.
ro...@telus.net
<now...@nowhere.net> wrote:
>sinister wrote:
>
>> And so we get results like what happened in Cleveland during the 1990s.
>> There, a well-publicized initiative sponsored by local businesses, hospitals
>> and physicians identified several hospitals as having significantly higher
>> than expected mortality rates, longer than expected hospital stays, and
>> worse patient satisfaction. Yet, not one of these hospitals ever lost a
>> contract because of their poor performance. To the employers buying health
>> care in the community, and presumably their employees as well, cost and
>> choice counted for more than quality. Developing more and better quality
>> measures in health care is a noble cause, but it's not clear that putting
>> more information into health-care markets will change these hard truths.
>
>Do you really and truly believe that having government run medical
>services will assure their quality?
No. Do you really and truly believe that having private ones will?
>Where is the incentive?
In the polling booth.
>Consider for
>a moment the quality of our state funded and run public schools. If this
>as a harbinger of quality assurance under tha aegis of government, we
>are in for a really bad time.
You are obviously not willing to know the fact that other countries
that have much better school systems than the American one have state
funded and run ones, too.
>On the other hand our supermarkets which are regulated to some degree
>but otherwise free market entities provide quality food with a minimum
>of government regulation and intervention. Do you think that medical
>services can be sold like calavoes are sold at the local supermarket.
No, I don't.
>If
>so, that is the way to run a good medical service system. Like the local
>supermarket.
You are also obviously not willing to know the fact, clearly (IMO)
explained in the article you claim to have read, that competition in
the medical industry cannot, repeat, _cannot_ work the same way as
competition in the supermarket industry, because patients cannot be as
informed and rational as shoppers.
>Do you also notice something else. There is no third party involved when
>you buy food. There is no "food insurance". There is the customer and
>there is the vendor and his supply chain. No third party determining how
>much food a person will get and at what quality.
?? You are also obviously not willing to know the fact that food
quality and safety in your local supermarket are assured by
third-party government agencies.
>The only way to have a
>good medical supply system is to remove third parties from the transaction.
<sigh> Leaving one informed, rational, and profit-motivated party,
and another uninformed, panicky, and pain-motivated (assuming he is
even conscious) party? Those sound like the conditions for an
efficient market, all right...
-- Roy L
ro...@telus.net
<now...@nowhere.net> wrote:
>sinister wrote:
>
>> Education does not equal medical care.
>
>That is right. It is much simpler and easier to provide and no one's
>life is in danger.
A while since you've been in an inner-city US public school, isn't it?
>If the government cannot do the simpler and easier
>well, why should we assume it can do the more difficult well?
Do you think it is easy to govern?
-- Roy L
ro...@telus.net
wrote:
>
><Big Dog> wrote in message
>news:2omh111hesgt8ubpt...@4ax.com...
>> On Sun, 20 Feb 2005 16:45:27 GMT, "sinister" <sini...@nospam.invalid>
>> wrote:
>>
>>>Socialized medicine---the *provision* of medicine, not just medical
>>>insurance (so-called "national health insurance")---is inevitable for
>>>reasons of economic efficiency.
>>
>> Economic efficiency? I will tell you what is most efficient
>> economically. We should not treat those that doctors do not think
>> will recover a good quality of life. That is economic efficiency.
>> Frankly, I am more concerned with medical quality.
>
>[Sigh] Clearly you didn't read the excerpt.
He may have read it, but simply not be intelligent enough to
understand it, like Kolker and Mental Disease.
-- Roy L
ro...@telus.net
>On Sun, 20 Feb 2005 16:45:27 GMT, "sinister" <sini...@nospam.invalid>
>wrote:
>
>>Socialized medicine---the *provision* of medicine, not just medical
>>insurance (so-called "national health insurance")---is inevitable for
>>reasons of economic efficiency.
>
>Economic efficiency? I will tell you what is most efficient
>economically. We should not treat those that doctors do not think
>will recover a good quality of life.
But who should make that decision? Doctors? What is their incentive
not to treat those who will not benefit by treatment, if it will
nevertheless be profitable to treat them?
>That is economic efficiency.
But in a free market, the doctors would not care how ineffective their
services were in restoring the terminally ill elderly's quality of
life. The seniors have all the money. They are afraid of illness and
death, and will pay a lot of that money for ineffective treatments
that promise deliverance from their suffering and fear. A free market
in medical care would devote all medical resources to those willing
and able to spend money for them, _entirely_independently_ of any
actual medical benefit they might receive from such expenditures.
>Frankly, I am more concerned with medical quality.
If there were some positive relationship between medical practitioner
profit and patient health outcomes, the free marketeers might have a
point. But there isn't. Indeed, the relationship is rather the other
way (hands up, all those who think Michael Jackson's plastic surgeon
spends any time giving vaccinations to kids in poor neighborhoods...).
So they don't have a point.
-- Roy L
ro...@telus.net
<now...@nowhere.net> wrote:
>MS wrote:
>>
>> The government isn't providing medicine; physicians and nurses are.
>
>You are ignoring the effects of government regulations and constraints
>on services. If the government gets into the act, medical services will
>be rationed. Also govern rules of licensure affect the availability of
>medical personal. Do direct managment is not required to have a real
>effect on services rendered.
>
>You may as well argue that government isn't providing public schooling,
>teachers are. But the involvement of goverment in the process has
>produced our famously piss poor public schools.
You are obviously not willing to know the fact that involvement of
government in the process has also produced the famously much better
public schools in other countries.
>As I said: if government involvement in the simpler matter of schooling
>has produced such dismal results, what will government involvement in
>the providison of medical services do?
Or in fighting a war...?
>When you want services provided at a reasonable price over a wide range
>of price and service options, you use a free market or freer market
>model.
Assuming the economic conditions are appropriate.
>Your local supermarket provides an excellent choice of edibles at
>a price you and I can afford. The government is involved in that process
>miminally (laws and commercial regulations). The market is competitive.
>If medical services can be provided in a model that resemebles the
>suprmarket model I suggest we may be better served than we are now.
But they can't. That's the point.
-- Roy L
MS
> <now...@nowhere.net> wrote:
>
>>sinister wrote:
>>
>>
>>>Unless you want to continue buffing up your reputation as a rabid
>>>anti-empiricist, please provide links to any evidence that the main
>>>empirical claim in the article---that the VHA is now providing high-quality
>>>health care---is wrong.
>>
>>High quality in comparison to what? Who made the determination. By what
>>objective criteria? Why should I believe this?
>>
>
ro...@telus.net
<now...@nowhere.net> wrote:
>sinister wrote:
>>
>> Second, the article provides the answer---the VHA is government run, and it
>> is far more efficient and offers far higher average quality of care than the
>> private system.
>
>Have you ever visited a VA Hosipital. I have. They are dismal and grim.
Though some are better than others, I have never been in any hospital
that struck me as especially cheery. But please explain how your
impression that they are "dismal and grim" can delete from objective
reality the fact that despite being government run, VHA hospitals
deliver better care at a lower cost than private hospitals.
-- Roy L
ro...@telus.net
<now...@nowhere.net> wrote:
>sinister wrote:
>>
>> But I'm sure you'll persist, since facts and substantial arguments never
>> seem to sway you.
>
>I see how government runs and is run every day.
No, you don't. You somehow delete from your consciousness all the
facts of objective reality that disprove your religion, such as the
fact that VHA hospitals deliver better care at lower cost than private
hospitals.
>My skepticism is perfectly justified.
No, it isn't. It is based purely on your refusal to know any fact
that does not fit your prejudices.
-- Roy L
ro...@telus.net
<now...@nowhere.net> wrote:
>Badly done medicine will be paid for a readily
>as well done medical service. In short there is no incentive to excel in
>quality.
And that would not change in a purely private system.
-- Roy L
MS
Who said government was "so great"? Another strawmen? There
are some sectors (few) of the economy that require government
involvement -- health care is one of them. Study the roles
information asymmetry, externalities, and uncertainty play in
the health care sector.
Arrow (Nobel Laureate) published an article, "Uncertainty and
the Welfare Economics of Medical Care" about these
characteristics in a 63 edition of the AER. However, if you
cannot understand the Washington Monthly, the AER is going to
give you trouble. Even if it is from 1963.
MS
He's made up his mind. How cruel of people to confuse him with
facts.
I believe markets do a better job in almost all situtation but a
few (you probably feel the same). The medical sector, however,
is one of those.
There are numerous studies showing that not-for-profit hospitals
provide better results than for-profit hospitals. Here's
another tid bit for market as religion people:
"In the United States, where 85 percent of renal dialysis
centers are for-profit, death rates for dialysis patients are 47
percent higher than in Canada, and more than one-half of
American patients are treated with reprocessed dialysis
(an unsafe practice). Twice as many patients in Canada get
kidney transplants as in the United States." -- Himmelstein, et
al., "Bleeding the patient".
tonyp
"Socialism is a Mental Disease" <root@localhost.> wrote
> The thing is, the guns of Government aren't being used to force you to
> support any corporation!
We will remember you said that, if you ever complain about your tax money
going to support PBS :-)
-- TP
robert j. kolker
ro...@telus.net wrote:
> also not honest enough to be willing to know the fact that VHA
> hospitals achieve better outcomes than private hospitals.
Better than some private hospitals. I have no doubt that there are badly
run private hospitals. There are also well run private hospitals.
Bob Kolker
robert j. kolker
MS wrote:
>
> So that's your plan: If the health care smells good and doesn't have
> bruises, you will purchase it?
You got it! It is like any other service. You buy the service you can
afford and within that range the best quality available.
The way things are run now with the HMO-s there is no incentive
whatsoever to excel in quality. The HMO is the of all possible outcomes
within the current system. There is a disconnect between customer
satisfaction and who is paying the bills.
Bob Kolker
robert j. kolker
ro...@telus.net wrote:
>
>
> No. Do you really and truly believe that having private ones will?
Yes. I believe it is possible. Once licensure is eliminated and free
entry into the field is possible, competition should produce sufficient
quality. It works for supermarkets and hardware stores. Why not medical
service? Competition to produce the best service at the best price is
currently lacking.
Bob Kolker
robert j. kolker
ro...@telus.net wrote:
>
>
> A while since you've been in an inner-city US public school, isn't it?
You make my case. This is the BEST the government can do in schooling.
The best schools of all are private and churchrun schools, not
government schools.
Bob Kolker
robert j. kolker
ro...@telus.net wrote:
> He may have read it, but simply not be intelligent enough to
> understand it, like Kolker and Mental Disease.
As it occured to you that I do not share the premises. I know from my
own experience that the best quality service and goods come from a
competitive system. Medical service is like any other. It is bought and
sold.
Bob Kolker
robert j. kolker
ro...@telus.net wrote:
> You are obviously not willing to know the fact that involvement of
> government in the process has also produced the famously much better
> public schools in other countries.
Irrelevent. Government in the United States of America is famously
incompetent to do much more than maintain an Army. Our government is
good at two things: lying to the public and making war.
The Amtrak trains don't run on time. Our space ships blow up or burn up.
The roads have potholes and are not repaired. The mail service is
mediocre on a good day. That is why most parcels are carried by private
carriers, so they get to where they are going on time. All these are
-simple- services and our government does not it well overall. Why
should I believed a government run medical system would by any good. If
you don't like the service, to what competitor do you go?
Bob Kolker
robert j. kolker
ro...@telus.net wrote:
> Though some are better than others, I have never been in any hospital
> that struck me as especially cheery. But please explain how your
> impression that they are "dismal and grim" can delete from objective
> reality the fact that despite being government run, VHA hospitals
> deliver better care at a lower cost than private hospitals.
Better care a treating what diseases. Do they treat heart and
circulatory disfunction better? Do they treat cancer better? Do the rich
and famous go to VA hospitals for open heart surgery or brain surgery?
If you want to know where the best service is being provided go to where
the rich and famous go to be treated.
Bob Kolker
robert j. kolker
ro...@telus.net wrote:
>
> And that would not change in a purely private system.
With competition, it will. It works for hardware stores, why not hospitals?
Bob Kolker
robert j. kolker
MS wrote:
>
> Who said government was "so great"? Another strawmen? There are some
> sectors (few) of the economy that require government involvement --
> health care is one of them. Study the roles information asymmetry,
> externalities, and uncertainty play in the health care sector.
It is the buyer's responsibility to seek the best product he can afford.
If he puts that decision process in the hands of strangers, he will be
screwed, just as sure as dawn breaks in the east.
We have a public that eats shitty food and won't excercise enough. In
addition most of the public is functionally illiterate and
scientifically ignorant. How would they know if their government
overseers are doing a good job? The only solution is for the public to
wise up, buy services with their own money and shop carefully for what
they need.
Bob Kolker
robert j. kolker
MS wrote:
> There are numerous studies showing that not-for-profit hospitals provide
> better results than for-profit hospitals. Here's another tid bit for
> market as religion people:
Non-profit corporations need not be government owned or government run.
There are thousands of -private- non-profit corporations. There is no
reason why we could not have non-profit corporation partake in the field
of medical services. The need not be government entities.
Bob Kolker
MS
>
>
> ro...@telus.net wrote:
>
>>
>>
>> No. Do you really and truly believe that having private ones will?
>
>
> Yes. I believe it is possible. Once licensure is eliminated and free
> entry into the field is possible, competition should produce sufficient
licensure eliminated? Are you sure? At one time things were
like that and results, necessitated licensure. Unless your
definition of licensure is different.
MS
Medical service is not like any other. Read Arrow, 1963, AER.
MS
The cognitive dissonance you and Mental Disease have to engage
in is legion.
MS
>
>
> MS wrote:
>
>>
>> Who said government was "so great"? Another strawmen? There are some
>> sectors (few) of the economy that require government involvement --
>> health care is one of them. Study the roles information asymmetry,
>> externalities, and uncertainty play in the health care sector.
>
>
> It is the buyer's responsibility to seek the best product he can afford.
> If he puts that decision process in the hands of strangers, he will be
> screwed, just as sure as dawn breaks in the east.
>
Unless a patient has a medical degree and years experience in a
hospital setting they don't know what they're buying.
> We have a public that eats shitty food and won't excercise enough. In
> addition most of the public is functionally illiterate and
> scientifically ignorant. How would they know if their government
> overseers are doing a good job? The only solution is for the public to
> wise up, buy services with their own money and shop carefully for what
> they need.
How do you shop carefully when you're in pain or unconscious?
robert j. kolker
MS wrote:
> licensure eliminated? Are you sure? At one time things were like that
> and results, necessitated licensure. Unless your definition of
> licensure is different.
Licence. A legal permit to do something.
A non-governmental assurance of skill or rating system could be through
degrees granted by recognized schools of medicine and one's rating on
generally accepted tests of competence.
If a person just wants a hangnail clipped, he need not go to a brain
surgeon. Can can get services from a board rated hangnail clipper.
Bob Kolker
MS
Governments do a good job of running education systems in other
countries and get excellent results.
robert j. kolker
MS wrote:
>
> Medical service is not like any other. Read Arrow, 1963, AER.
It is bought and sold, yes? That makes it like any other service, except
that the outcomes can be more serious. Which means the levels of
competence must be higher. Now how can we be sure of the competence of
people appointed by popularly elected government officials, by the mob
de jure?
Bob Kolker
MS
> On Mon, 21 Feb 2005 21:24:51 GMT, MS <mik...@iname.com> wrote:
>
>>Socialism is a Mental Disease wrote:
>>
>>>On Mon, 21 Feb 2005 14:49:30 -0500, "robert j. kolker"
>>><now...@nowhere.net> wrote:
>>>
>>>
>>>>sinister wrote:
>>>>
>>>>
>>>>
>>>>>Unless you want to continue buffing up your reputation as a rabid
>>>>>anti-empiricist, please provide links to any evidence that the main
>>>>>empirical claim in the article---that the VHA is now providing high-quality
>>>>>health care---is wrong.
>>>>
>>>>High quality in comparison to what? Who made the determination. By what
>>>>objective criteria? Why should I believe this?
>>>>
>>>
>>>
>>
>>Shhhh, quiet while the adults are talking dear.
>>
>
>
> You are repeating yourself again. It's time for your medication.
And you've never said that before? What a zinger!
>
>
robert j. kolker
MS wrote:
>
> Unless a patient has a medical degree and years experience in a hospital
> setting they don't know what they're buying.
That is strange. I never went to medical school, but I read the medical
and technical journals. When I had parathyroid surgery done some years
ago, I pulled the medical text books on the procedure and learned what
the operation is and what it was done. In addition I taught myself the
physiology and function of the parathyroid glands (there are four
located around the tyhroid, hence the name). Now if I can do it, anybody
can.
I constantly research the latest diagnostic techniques and treatments.
The closest I came being involved in medical services was when I worked
for company that manufactured catheters and stents. I had to learn about
the circulator system and how catheters are used to deliver x-ray opaque
dye into the arteries to spot blockage and bad flow.
The technique has improved quite a but and they use real time NMR for
that these days.
Anyone who can read can learn enough medicine concerning any condition
he might be suffering. He can learn enough to ask intelligent questions
of the doctors.
American know about their cars, so I don't see why they can't know about
their bodies.
Bob Kolker
MS
<sigh> You owe it to yourself to read that Arrow article or
http://www.oheschools.org/ohech3pg1.html
First year economics does not cut it when it comes to analyzing
markets for medical services.
>
> Bob Kolker
robert j. kolker
MS wrote:
>
> Governments do a good job of running education systems in other
> countries and get excellent results.
I am talking about the U.S.A. where both the government and electorate
is incompetent. Andrew Jackson started a downhill slide in quality of
both the government and electorate and that slide has not stopped since.
Bob Kolker
MS
>
>
> MS wrote:
>
>> licensure eliminated? Are you sure? At one time things were like
>> that and results, necessitated licensure. Unless your definition of
>> licensure is different.
>
>
> Licence. A legal permit to do something.
>
> A non-governmental assurance of skill or rating system could be through
> degrees granted by recognized schools of medicine and one's rating on
> generally accepted tests of competence.
>
Do you really want to eliminate that?
Les Cargill
>
>
> sinister wrote:
>
>> Unless you want to continue buffing up your reputation as a rabid
>> anti-empiricist, please provide links to any evidence that the main
>> empirical claim in the article---that the VHA is now providing
>> high-quality health care---is wrong.
>
> High quality in comparison to what? Who made the determination. By what
> objective criteria? Why should I believe this?
>
> Even granting the point there is no assurance that the government will
> supply high quality care nationwide to everyone. Governments have a very
> bad record in quality and efficiency.
>
> Let me ask you a question. Would you like the entire food production and
> distribution system of the counry government run?
It is.
> Would you expect to be
> as well fed?
We are.
> Do you want the workers in the local food store to be
> government employees? If government is so great why not have it run
> everything?
>
See also "the public goods problem" . Is medicine a public good?
Sort of. It's almost perfectly inelastic in demand, anyway....
> Bob Kolker
>
--
Les Cargill
Les Cargill
Because a negative experience at a hardware store does not
leave the consumer dead. And someone in the clutches of a heart
attack is in no position to argue about price.
--
Les Cargill
Les Cargill
>
>
> sinister wrote:
>
>>
>> The excerpt I posted quite clearly shows that private-sector
>> physicians and hospitals have no economic incentive to provide health
>> care based on the long-term health of the patient.
>
>
> And the bosses of the doctors under your proposed scheme will be
> government burocrats and lackeys. The bosses of your postman constitute
> the U.S. Postal Service and we know what a wonder of efficiency that is.
It is now competitive with UPS and FedEx - at least
in the ballpark. USPS is a perfectly valid shipping
choice.
> That is why the U.S. government uses FedEx and Mr. Brown to ship their
> parcels.
>
That would be incorrect.
Les Cargill
>
>
> sinister wrote:
>
>>
>> And there's now empirical evidence that this is true. Re-read the
>> excerpt (really, read the entire article, at the URL).
>
>
> I read the article and I consult my own experieince in dealing with
> governments as various levels. I would prefer a wide open capitalistic
> free for all in medicine with no licensure. There will be a wide range
> of options and if the consumer is careful he will get his money's worth.
> I like the supermarket model best of all. Supermarkets provide good food
> over a wide range of prices and all good quality with respect to a given
> price range. Competition is what makes it tick.
>
> Bob Kolker
>
You can't get there from here. And supermarkets are
the retail end of one of the most incredibly subsidized and
managed systems of production known to man.
--
Les Cargill
Les Cargill
> "MS" <mik...@iname.com> wrote in message
> news:EM8Sd.444756$8l.343094@pd7tw1no...
>
>>robert j. kolker wrote:
>>
>>>
>>>sinister wrote:
>>>
>>>
>>>>And so we get results like what happened in Cleveland during the 1990s.
>>>>There, a well-publicized initiative sponsored by local businesses,
>>>>hospitals
>>>>and physicians identified several hospitals as having significantly
>>>>higher
>>>>than expected mortality rates, longer than expected hospital stays, and
>>>>worse patient satisfaction. Yet, not one of these hospitals ever lost a
>>>>contract because of their poor performance. To the employers buying
>>>>health
>>>>care in the community, and presumably their employees as well, cost and
>>>>choice counted for more than quality. Developing more and better quality
>>>>measures in health care is a noble cause, but it's not clear that
>>>>putting
>>>>more information into health-care markets will change these hard truths.
>>>
>>>
>>>Do you really and truly believe that having government run medical
>>>services will assure their quality? Where is the incentive? Consider for
>>>a moment the quality of our state funded and run public schools. If this
>>>as a harbinger of quality assurance under tha aegis of government, we are
>>>in for a really bad time.
>>
>>Every proposal I've seen for "fixing" health care involves the government
>>in the role of bill payer. Hospital and physicians would deliver care
>>privately to their patients. Perhaps better data could be collected so
>>patients and their doctors could make better choices?
>
>
> The point of my post is that government should also be the provider, meaning
> that hospitals should be run by the government and physicians should be
> employeed by the government.
>
> The excerpt I posted quite clearly shows that private-sector physicians and
> hospitals have no economic incentive to provide health care based on the
> long-term health of the patient.
>
>
I don't particularly care for *that* system,
because it implies that we're all just so much
productive inventory to be managed by the Gummint.
It's Orwellian. If there is no evidence of
enlightened self-interest at the level of the end
customer, the whole thing breaks down.
This is also difficult in a climate in which
the USPS is being used as the template for
movements to "privatize" a lot of government
services. Don't lay this at Bush's feet; it
preceeds his administration.
I say let 'em be Government overseen ( at the board
level, and in minimal-impact audit capabilities )
not-for-profits.
And if the well-established religious hospital
systems want to play, let 'em.
--
Les Cargill
MS
>
>
> MS wrote:
>
>>
>> Unless a patient has a medical degree and years experience in a
>> hospital setting they don't know what they're buying.
>
>
> That is strange. I never went to medical school, but I read the medical
> and technical journals. When I had parathyroid surgery done some years
> ago, I pulled the medical text books on the procedure and learned what
> the operation is and what it was done.
That is a good thing (tm Martha Stewart), but only after the
doctor told you you needed parathyroid surgery or that there was
something wrong with your parathyroid.
After I had a benign lump removed from my forearm I surfed the
web and found some information on wound care. But what if my
doctor told me it was something else, like cancer or a polyp on
a tendon or something (who knows, I'm not a doctor) and billed
my insurer for elaborate treatment that wasn't required?
How do you know your doctor's diagnoses and prescription for
cure were correct? With the way the US system is rigged there
are a lot of unnecessary surgeries taking place (often harmful
to patients). More so than in other countries.
Costs continue to escalate faster in the USA than elsewhere in
the world. This system will fail as surely as communism failed
in Russia and Eastern Europe. There are some things that should
be left to the market and a few things large monopolistic
organizations should provide -- utilities, health care, police,
military, etc...
What is your worst fear about the introduction of single payer
health care?
The Trucker
>
>
> ro...@telus.net wrote:
>
>> He may have read it, but simply not be intelligent enough to
>> understand it, like Kolker and Mental Disease.
>
> As it occured to you that I do not share the premises. I know from my
> own experience that the best quality service and goods come from a
> competitive system. Medical service is like any other. It is bought and
> sold.
>
> Bob Kolker
And Bob KNOWS that is true because God is on his side and all evidence
to the contrary is the work of Satan.
--
"I know no safe depository of the ultimate powers of society but
the people themselves; and if we think them not enlightened enough
to exercise their control with a wholesome discretion, the remedy
is not to take it from them, but to inform their discretion by
education." - Thomas Jefferson. http://GreaterVoice.org
robert j. kolker
Les Cargill wrote:
>
>
> It is.
No it isn't. I may be regulated by law, but the players are private
corporations and privately owned firms that processess, distribute and
market the food to the public.
The government burocrats neither sow nor reap. Nor do they butcher
animals, nor do they prepare food for sale.
Bob Kolker
robert j. kolker
Les Cargill wrote:
>
> Because a negative experience at a hardware store does not
> leave the consumer dead. And someone in the clutches of a heart
> attack is in no position to argue about price.
If the customer eats right and excercises he does not get into that
situation either. A public in which individuals do not or cannot care
for their own bodies make very uniformed consumers of medical services.
But what about us folkds who do excercise and mind what we eat. Do we
get an opt out from government medicine. Is there a parallel system of
private medicine we can buy into, or does the government have a
monopolistic hammerlock on mediocrity as it does with elementary schools?
Bob Kolker
robert j. kolker
Les Cargill wrote:
>
> It is now competitive with UPS and FedEx - at least
> in the ballpark. USPS is a perfectly valid shipping
> choice.
No it isn't. It has improved some, but it doesn't deliver as reliably on
time.
Bob Kolker
robert j. kolker
Les Cargill wrote:
> You can't get there from here. And supermarkets are
> the retail end of one of the most incredibly subsidized and
> managed systems of production known to man.
The end you and I see are stores that compete with each other in quality
and price.
Bob Kolker
robert j. kolker
MS wrote:
>
> What is your worst fear about the introduction of single payer health care?
That is not my fear. My fear is government regulation of the technical
aspects of medical care. If the government pays fine. All I want is an
opt out so I can by my medical care on the free market (or as free as
the market can get). I want to be treated by doctors who are not in the
employ of the government.
What I think we will get as an abomimation not any better than the HMO
system we have now, but without a scintilla of competition. It took UPS
and FedEx to make the USPS improve its service. Once the government has
a lock on medicine, where is the incentive for quality?
Bob Kolker
robert j. kolker
The Trucker wrote:
> And Bob KNOWS that is true because God is on his side and all evidence
> to the contrary is the work of Satan.
You are telling me that medical services are not bought and sold? How
are they paid for then?
Bob Kolker
>
Les Cargill
>
>
> Les Cargill wrote:
>
>>
>> Because a negative experience at a hardware store does not
>> leave the consumer dead. And someone in the clutches of a heart
>> attack is in no position to argue about price.
>
>
> If the customer eats right and excercises he does not get into that
> situation either.
That's only partially true. Life is a fatal,
sexually transmitted disease, after all.
> A public in which individuals do not or cannot care
> for their own bodies make very uniformed consumers of medical services.
>
But we cannot overturn enlightened self interest.
Even for the unenlightened and self-disinterested.
Nobody's ever been able to say conclusively that,
short of transplants or other heroic measures,
those who do not conform to some actuarial wet
dream cost more, anyay. They might during a critical
period, but I don't know that it's true over
a lifespan.
In principle, pay as you go would be the ideal
system, but we now have a mess. It precludes
pay as you go without wrecking the market
for services utterly. At the very least, there
must be an interim system.
Heck, the vast majority of expenditures are
in the last few months of life. The hospice
movement and others question the utility of
this. I do not want that for myself.
> But what about us folkds who do excercise and mind what we eat. Do we
> get an opt out from government medicine. Is there a parallel system of
> private medicine we can buy into, or does the government have a
> monopolistic hammerlock on mediocrity as it does with elementary schools?
>
If you reprofessionalize teaching, you'll get
better results. It'll take determination
and probably more political will than is available
today.
And a well designed system would allow those who can
afford it to pay their own way. All we are really
talking about is bringing those services which clog
emergency rooms into the light of day, hopefully
at lower cost.
This whole thing is because perks were given
during the wage freezes after WWII. Blue Cross
was one.